Search for tag: "scoliosis"

Dr. Miller: Surgery for spinal scoliosis. We're going to talk about that next on Scope Radio.

Announcer: Access to our experts with in-depth information about the biggest health issues facing you today. The Specialists with Dr. Tom Miller is on the Scope.

Dr. Miller: Hi, I'm Dr. Tom Miller and I'm here with Dr. Darrel Brodke, he's an orthopedic surgeon at the University of Utah. He's also a spine specialist. Darrel, after conservative therapy some patients may not do as well as expected and they end up in your hands again where you may advise surgery. Tell us a little bit about that expectation and what happens.

Dr. Brodke: Patients often with adult scoliosis often caused by degenerative disease, degenerative disc disease, and therefore in a subsequent deformity also have other problems related to that lumbar spine. Specifically low back pain and pain radiating into their legs. They may also have pain with associated numbness and weakness and fatigue. All of that may progress despite non-operative treatment, despite physical therapy, medications, even injections. And it's then that we start to talk about surgical intervention. And surgery often necessitates a big surgery, not a little surgery, and by big surgery I mean surgery that may take many hours and require several days in the hospital and several months of recovery.

Dr. Miller: This is because you're operating on multiple levels of the spine, trying to straighten that curve that shouldn't be there.

Dr. Brodke: Exactly. We're working both on making room for the nerves, decompressing anything that's pressing on the nerves, and then straightening the spine and holding it there with metal instrumentation: screws and rods and spacers.

Dr. Miller: So this is a long surgery, but I imagine the recovery is also long.

Dr. Brodke: Yes. The surgery itself can take many hours. It varies depending on how many levels of the spine are involved and how much we need to do. The recovery, likewise, can vary but usually is on the order of months, not on the order of hours or days.

Dr. Miller: So tell us how you advise, sounds like the rehabilitation after the surgery is a significant part of the treatment. So do you send a patient to just physical therapy or do you send them to a physical therapy physician? Tell us a little bit about that.

Dr. Brodke: Postoperatively we're working with physical therapy immediately after surgery. While still in the hospital, patients are getting up and walking and learning techniques of movement and balance with a physical therapist. Once they leave the hospital, some patients go straight home and can walk as their main therapy and their therapy for the next few months as the bone is healing is walking. Some patients aren't quite ready to go home and will end up in a rehab facility where they work every day with physical therapy until their strength and balance has come around.

Dr. Miller: And that's very intensive

Dr. Brodke: It can be very intensive, several hours a day work in order to get to the point where they're ready to be walking around the home and even outside the home.

Dr. Miller: Now you mentioned you put some hardware in the back and to straighten the spine, I think you use metal rods and hooks and things like that and it sounds kind of daunting and it actually really helps straighten that spine.

Dr. Brodke: Yes, it does sound daunting and it's rather impressive when patients and their families see the X-rays but the screws and rods that we use, mostly made out of titanium today, really help us straighten the spine and hold it there while the spine is healing from the surgery.

Dr. Miller: So the hardware once it's implanted doesn't cause pain. It actually helps prevent it.

Dr. Brodke: Exactly. It helps prevent the pain, it helps hold the position that we want to hold, and it doesn't really hurt long-term either. Most patients don't need their hardware removed. It just goes along for the ride for the rest of however long that ride is.

Dr. Miller: So for our audience, it sounds like a small number of patients would need to have surgery to repair scoliosis. Basically this is a long and complex procedure followed by several months of rehabilitation but at the end of that if everything is going correctly you're going to feel better, you're going to have a better . . . going to have less pain, and you're going to be more functionable with your life.

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Dr. Miller: Scoliosis - A Bend in the Spine. We're going to talk about that next on Scope Radio.

Announcer: Access to our experts with in-depth information about the biggest health issues facing you today. The Specialists with Dr. Tom Miller is on The Scope.

Dr. Miller: Hi, I'm Dr. Tom Miller and I'm here with Dr. Darrel Brodke. He's an orthopedic surgeon and a spine specialist here at the University of Utah. Darrel, what is scoliosis exactly?

Dr. Brodke: Scoliosis is a curve in the spine. Technically it's a curve that goes sideways in the spine, because our spine naturally curves in the forward-backward plane, but sideways it's supposed to be straight.

Dr. Miller: How do we get scoliosis, which sounds kind of abnormal?

Dr. Brodke: Yeah, there are a number of ways to get scoliosis. The most common, frankly, is arthritis in the spine as an older adult. That is a very common way to get scoliosis as an adult. But what we commonly think of when we think of scoliosis is teenaged kids with a curvature in the spine that was picked up by the school nurse. That's called, the most common version of that, adolescent idiopathic scoliosis, and it's also fairly common but not quite as common as the degenerative kind in the elderly.

Dr. Miller: So we hear that a lot of people have scoliosis. Do the majority of those people not have problems, they just live with the scoliosis?

Dr. Brodke: Absolutely. In fact, most kids and adults with scoliosis often find out they have scoliosis because they're being evaluated for a different problem and never really had known that they had scoliosis before that evaluation and it doesn't really affect them in any way.

Dr. Miller: It doesn't change their lifestyle, doesn't impact their livelihood.

Dr. Brodke: Exactly.

Dr. Miller: And it doesn't progress?

Dr. Brodke: It doesn't progress in most people.

Dr. Miller: Now the other type of scoliosis you mentioned is due to arthritis, so as patients are getting older that sounds a little more concerning.

Dr. Brodke: It can be. It can also be fairly benign. It can be an incidental finding when somebody is being evaluated for low back pain, for a muscle strain, for example, and it might have nothing to do with the low back pain. Alternatively, it may be very involved in the patient's problem in their low back, for example, when there's involvement of nerve compression, and we often see that in degenerative scoliosis.

Dr. Miller: Now patients that have scoliosis who don't have any problems, I suppose they would not need to see anyone. When would a person with scoliosis need to see a spine surgeon such as yourself? Would it be because of pain or limited mobility?

Dr. Brodke: There are probably two main reasons and then a third that's common. I'll start with that third. The common reason is because they're concerned about it. They don't know very much about it and they want to talk to somebody who treats this regularly and would like to get more information. That's a very common reason to see a physician, and that's a completely valid reason. Most of those appointments are about patient education and reassurance and they don't lead to surgical intervention.

There are times when the scoliosis can be a problem and should be seen by a specialist that sees and treats and operates on scoliosis. Probably the most common in adults, the adult scoliosis form, is when the patient feels very out of balance, either forward or sideways in a way that they can't straighten up, or they feel like their pain radiates down their legs and/or they have numbness and weakness in their legs and they can't do the things that they would like to do.

Dr. Miller: So treatments would include graded therapy. So you'd start conservatively or do you need to go to operative therapy?

Dr. Brodke: We will almost always start conservatively with physical therapy and medications like ibuprofen or naproxen, anti-inflammatory medicines, and sometimes we'll escalate to an epidural steroid injection or a little bit more aggressive treatment of pain. And if all of those fail we may talk about surgery.

Dr. Miller: So the small percentage of patients with scoliosis would go on to surgery?

Dr. Brodke: That's correct.

Dr. Miller: So to wrap that up for our audience, basically scoliosis is a fairly common condition especially in the younger patients or in younger people, and usually is not progressive, does not cause symptoms, and you live with it without any trouble whatsoever. But in some people it is problematic. It can impair function, it can cause pain, and for that reason you would see a spine specialist and they would prescribe variable therapy from conservative therapy, including physical therapy and non-opioid analgesics such as ibuprofen and Naprosyn, and then a few would need surgery ultimately.

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updated: June 25, 2019
originally published: June 14, 2016